Military Hospital System Needs Review, Not Secrecy

May 26, 1985

THE DEPARTMENT OF DEFENSE claims it needs to cloak its hospital system in secrecy so that military doctors will honestly evaluate their peers.

But the department`s incipient quest to make secret most records concerning the quality of medical care offered to 10 million active-duty personnel, retirees and dependents will do more harm than good to a system already under fire for lax management and inferior quality.

A draft bill that would shut off access to information is awaiting Defense Secretary Caspar Weinberger`s go-ahead for presentation to Congress. The bill would shield all proceedings, records, minutes and reports of committees that evaluate the credentials of doctors or investigate problems such as high surgical death rates. Disclosure of secret information would carry a fine of up to $20,000.

The proposal is patterned after a 1980 law, which gave the Veterans Administration the authority to withhold from the public ``quality assurance`` information on its hospital system. VA officials claimed the same motivation -- candid peer review among physicians -- for the secrecy law. But that law has in fact been used to withhold personal medical information from patients and to conceal exceptionally high death and injury rates, an important tool in determining the quality of patient care and physician competency.

An 11-year history of unacceptably high death rates in the heart surgery programs of 12 VA hospitals was kept secret under that law until the News/Sun- Sentinel won the release of VA documents through a federal lawsuit.

Recent events preceding the Defense Department`s growing interest in secrecy also make the department`s motivations highly suspect. In the past year, stories critical of the quality of military medical care have occurred with increasing regularity in the national news media. The stories have revealed a 41 percent increase in Defense Department medical malpractice payouts from 1982 to 1984 and a weak system of quality control over doctors in each branch of the service.

Perhaps the most publicized case of defense hospital mismanagement is that of Cmdr. Donal M. Billig. Billig was hired as a heart surgeon at Bethesda Naval hospital after serious questions about his competence were raised by the staff of a private New Jersey hospital, where he previously had worked. His rights to practice at Bethesda have been suspended pending an investigation of how he was recruited and received credentials to practice in the Navy.

The legislation contemplated by the Department of Defense would give officials the authority to suppress information on Billig`s case, and could be used to intimidate whistle-blowers and to conceal the quality of health care.

Private hospitals now are forced by federal law to release death and injury statistics, and military and VA hospitals should be held to the same requirements. Clearly, patients have the right to review the performance of medical facilities where they are being treated or where they are contemplating treatment -- no matter whether they are civilians, active duty military personnel or veterans.

In light of the VA`s abuse of its secrecy law, the same opportunity for abuse should not be given to the Department of Defense. The proposal to make secret many aspects of military health care should find a final resting place in Weinberger`s trash can.